Metastatic yolk sac tumor, tumor thrombus in left atrium

Case contributed by Dr Yair Glick

Presentation

Palpable scrotal mass, chest pain.

Patient Data

Age: 25 years
Gender: Male
Ultrasound

Scrotal ultrasound

Left scrotum
Testis and epididymis are displaced upwards, show normal size and echotexture. Normal arterial flow demonstrated within testis.

Right scrotum
Huge scrotal mass chiefly involving scrotal soft tissues, showing heterogeneous echotexture with many small liquid, possibly necrotic, foci. Vascular flow demonstrated within the mass.
Testis and epididymis eccentrically displaced by mass, showing heterogeneous uneven echotexture. Vascular flow demonstrated within them.
Septated hydrocele noticed.

X-ray

Chest X rays upright

Large oval mass in left hemithorax, its epicenter in the left upper lobe, displacing the trachea to the right and creating a silhouette sign with the left upper heart border.
Innumerable rounded nodules scattered throughout both lungs.

The patient underwent radical orchiectomy, following which a CT chest-abdomen-pelvis was performed for staging:

CT

CT chest-abdomen-pelvis

Mediastinal and retrocrural lymphadenopathy.
Solid vascular mass measuring 10.3 x 12.1 x 8.0 cm in the left upper mediastinum, protruding in large part into the left hemithorax. The mass insinuates into the left atrium though the left upper pulmonary vein - tumor thrombus.
Numerous rounded solid nodules with maximum diameter of 2.9 cm scattered thoughout the lungs, most probably metastases.
Minuscule amount of pleural fluid on the left.

Heterogeneous solid confluent masses surround the abdominal aorta, most probably representing massive retroperitoneal lymphadenopathy, including enlarged necrotic lymph nodes.
There is erosion into the L2 vertebra on the right, resulting in a pathological fracture and soft tissue fullness within the spinal canal.
Small amount of free intraperitoneal fluid.
Post-surgical changes in the scrotal surgical bed as well as in the right groin and right lower abdominal wall.

To summarize:
Large upper mediastinal mass on the left, including tumor thrombus in left atrium.
Numerous bilateral pulmonary nodules, most probably metastases.
Mediastinal and retrocrural lymphadenopathy.

Massive retroperitoneal lymphadenopathy.
Erosion into L2 vertebra with resultant pathological fracture and soft tissue fullness.

Case Discussion

The pathology report stated that the right scrotal mass was a yolk sac tumor with interspersed mixed germ cell tumor components.

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Case information

rID: 61897
Published: 23rd Jul 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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